Respiratory System Face Muscle Weakness Case Study: Biology Answers 2021

Respiratory System Face Muscle Weakness Case Study: Biology Answers 2021

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Respiratory System Face Muscle Weakness Case Study

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Module 3 Case Study: Respiratory System Ch. 22
Respiratory Case History: A 22-year-old man was in a motorcycle accident with resultant neck
injuries that led to partial paralysis of the upper and lower limbs. Almost immediately his chest
felt heavy and he became dyspneic.
His pulmonary function values were as follows:
Vital capacity (supine)
Minute ventilation (supine)
Respiratory rate (supine)
650 mL
6 L/min
30 b/min
61 mm Hg
47 mm Hg
Case Study #3
Chief Complaint: A 26-year-old woman with muscle weakness in the face.
History: Jill Rothman, a 26-year-old gymnastics instructor, presents with complaints of muscle
weakness in her face that comes and goes, but has been getting worse over the past two
months. Most notably, she complains that her ?jaw gets tired? as she chews and that
swallowing has become difficult. She also notes diplopia (?double vision?) which seems to
come on late in the evening, particularly after reading for a few minutes. At work, it has
become increasingly difficult to ?spot? her gymnasts during acrobatic moves because of upper
arm weakness.
On physical examination, she has notable ptosis (?drooping?) of both eyelids after repeated
blinking exercises. When smiling, she appears to be snarling. Electromyographic testing
revealed progressive weakness and decreased amplitude of contraction of the distal arm
muscles upon repeated mild shocks (5 shocks per second) of the ulnar and median nerves.
Both her symptoms and electromyographic findings were reversed within 40 seconds of
intravenous administration of edophonium (Tensilon), an acetylcholinesterase inhibitor (i.e., an
?anticholinesterase?). Blood testing revealed high levels of an anti-acetylcholine receptor
antibody in her plasma, and a diagnosis of myasthenia gravis was made.
Jill was treated with pyridostigmine bromide, which is a long-acting anticholinesterase drug,
and was also started on prednisone, which is a corticosteroid drug. She also underwent
occasional plasmapheresis when her symptoms became especially severe. She was given a
prescription of atropine as needed to reduce the nausea, abdominal cramps, diarrhea, and
excessive salivation she experienced as side effects of the anticholinesterase drug.

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